Dr Matthew James Peters and colleagues from Australia conducted a meta-analysis of randomized evidence.
The research team determined the relative merits of laparoscopic anti-reflux surgery and open anti-reflux surgery for proven gastro-esophageal reflux disease (GERD).
The team searched Medline, Embase, Science Citation Index, Current Contents, and PubMed databases identified all randomized clinical trials that compared laparoscopic anti-reflux surgery and open anti-reflux surgery.
The team identified articles that were published in the English language between 1990 and 2007.
The team carried out a meta-analysis in accordance with the Quality of Reporting of Meta-Analyses statement.
The 6 outcome variables analyzed were operating time, hospital stay, return to normal activity, perioperative complications, treatment failure, and requirement for further surgery.
Random-effects meta-analyses were carried out using odds ratios, and weighted mean differences.
The researchers found 12 trials were considered suitable for the meta-analysis.
|There was a statistically significant reduction of 65%.|
|American Journal of Gastroenterology |
A total of 503 patients underwent open anti-reflux surgery, and 533 had laparoscopic anti-reflux surgery.
For 3 of the 6 outcomes, the summary point estimates favored laparoscopic anti-reflux surgery over open anti-reflux surgery.
The team found there was a significant reduction of 3 days in the duration of hospital stay for the laparoscopic anti-reflux surgery group.
The team found a significant reduction of 8 days in return to normal activity for the laparoscopic anti-reflux surgery group compared with that for the open anti-reflux surgery group.
There was a statistically significant reduction of 65% in the relative odds of complication rates for the laparoscopic anti-reflux surgery group compared with that for the open anti-reflux surgery group.
The duration of operating time was significantly longer in the laparoscopic anti-reflux surgery group.
Treatment failure rates were comparable between the 2 groups.
Despite this, the requirement for further surgery was significantly higher in the laparoscopic anti-reflux surgery group.
Dr Peters' team concluded, “On the basis of this meta-analysis, the authors concluded that laparoscopic anti-reflux surgery is an effective and safe alternative to open anti-reflux surgery for the treatment of proven GERD.”
“Laparoscopic anti-reflux surgery enables a faster convalescence and return to productive activity, with a reduced risk of complications and a similar treatment outcome, than an open approach.”
“However, there is a significantly higher rate of re-operation of 79% in the laparoscopic anti-reflux surgery group.”